J Korean Med Sci.  2005 Oct;20(5):908-911. 10.3346/jkms.2005.20.5.908.

Acrodermatitis Enteropathica-like Eruption Associated with Combined Nutritional Deficiency

• Kim YJ
• Kim MY
• Kim HO
• Lee MD
• Park YM

• KMID: 1781784
• DOI: http://doi.org/10.3346/jkms.2005.20.5.908

Abstract

We present here a case of acrodermatitis enteropathica-like eruption associated with essential free fatty acid and protein deficiencies as well as borderline zinc deficiency that occurred after Whipple's operation in a 31-yr-old woman. Her eruptions were improved not by zinc supplements alone, but her condition was improved by total parenteral nutrition including amino acids, albumin, lipid and zinc. Although we could not exactly decide which of the nutrients contributed the most to her manifestations, we inferred that all three elements in concert caused her dermatoses. This case shows that even though the patient's skin manifestations and laboratory results are suggestive of acrodermatitis enteropathica, the physicians should keep in mind the possibility that this disease can be associated with other nutritional deficiencies such as free fatty acid or protein deficiency.

Keyword

Acrodermatitis; Acrodermatitis Enteropathica; Malnutrition; Zinc; Fatty Acids, Essential; Protein Deficiency

MeSH Terms

Acrodermatitis/*diagnosis/*etiology
Adult
Fatty Acids, Essential/deficiency
Female
Humans
Malnutrition/*diagnosis/*etiology
Pancreatectomy/*adverse effects
Protein-Losing Enteropathies/diagnosis/etiology
Skin Diseases/*diagnosis/*etiology
Zinc/deficiency

Figure

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  Fig. 1 (A) Interconnected, erythematous, scaly, erosive patches, papules and tiny vesicles on the lower back and buttocks. (B) After 1 month of treatment with total parenteral nutrition, oral zinc supplement and topical linoleic acid.

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  Fig. 2 (A) Irregular acanthosis, mild parakeratosis and dermal perivascular infiltration. (B) Upper epidermal clear cell changes (H&E, (A) ×100, (B) ×200).

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  Fig. 3 (A, B) Erosion of the finger tips. (C) Diffuse alopecia and yellowish change of hair.

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